A Swedish retrospective case-control study has found that people with HIV and solid organ transplant recipients were significantly more likely to develop human papillomavirus (HPV)-associated anal, penile, vulvar and cervical cancers, than age- and sex-matched controls in the general population, reports MedPage Today.
Patients with HIV were more than four times more likely to develop any HPV-related cancer (adjusted odds ratio [aOR] 4.50, 95% CI 3.46-5.84), reported Christina Carlander, MD, PhD, of the Karolinska Institutet in Stockholm, and colleagues, in JAMA Network Open.
And transplant recipients had more than double the likelihood (aOR 2.23, 95% CI 1.85-2.68), with significantly increased odds observed after heart (aOR 2.91), lung (aOR 2.71), kidney (aOR 2.17), and liver (aOR 1.89) transplant, their findings showed.
“Overall, our findings reinforce the importance of targeted prevention strategies in immunosuppressed populations and suggest there is still room to improve both awareness and implementation of preventive measures in clinical practice,” co-author Eva Meglic, MSc, also of the Karolinska Institutet, told MedPage Today.
Among people with HIV, significantly increased odds were observed for anal (aOR 58.79), penile (aOR 8.05), vulvar (aOR 7.76), and cervical (aOR 2.55) cancers, with low CD4 counts –a marker of more advanced or less-controlled HIV – boosting those odds.
In the transplant recipients, increased odds were observed for the same four HPV-linked cancers: anal (aOR 2.70), penile (aOR 6.01), vulvar (aOR 7.07), and cervical (aOR 1.87) cancers.
No such associations were observed for HPV-related vaginal or oropharyngeal cancers in either group.
Long-term immune function impairment puts people with HIV and transplant recipients at increased risk of HPV-related cancers, Meglic said, by reducing the immune system's ability to clear persistent HPV infection and keep precancerous lesions from becoming cancerous.
HPV-related cancer risks are variable and shaped by a person’s immune status, treatment history, and socio-demographic factors. That requires an individualised and risk-informed approach to prevention, she noted.
The broader risks faced by these two groups “highlight the importance of timely HPV vaccination, maintaining effective HIV viral suppression, optimising immunosuppressive regimens where possible, and improving access to appropriate screening and early detection strategies in high-risk groups”, she added.
The case-control study from Carlander, Meglic, and colleagues looked at Swedish adults from 1983 to 2024 and included 32 093 individuals with HPV-related cancers and 320 930 matched controls free of any HPV-related cancer.
Overall, about two-thirds were women and 40% were under 50 at cancer diagnosis. Cervical cancer was the most common HPV-related cancer (42%), followed by oropharyngeal (35%), anal (9%), vulvar (7%), penile (5%), and vaginal (1%) cancers.
Lower income and not being married were linked with greater odds of HPV-related cancers among people with HIV, Meglic said, which may reflect differences in healthcare access, preventive care engagement, or earlier detection.
Associations with socio-demographic factors were less consistent in transplant recipients; but overall, the findings point to potential disparities in cancer prevention and diagnosis across both populations, the team said.
Study limitations included a lack of data on behavioural risk factors such as smoking, sexual behaviour, and alcohol use (which could confound associations with non-HPV oropharyngeal and anal cancers), along with the possibility that some cancers could have been developing before an organ transplant.
The Swedish Research Council and the Swedish Research Council for Health, Working Life, and Welfare supported the study.
Study details
Human papillomavirus–related cancer in people with HIV and solid organ transplant recipients
Eva Meglic, Alexander Ploner, Yunyang Deng et al.
Published in JAMA Network Open on 30 June 2026
Key Points
Question Are people with HIV (PWH) and solid organ transplant recipients (SOTRs) at higher risk of human papillomavirus (HPV)–related cancers compared with those without HIV or SOT, and how do clinical and socio-demographic factors modify the odds?
Findings In this nested case-control study in Sweden including 32 093 HPV-related cancer cases and 320 930 population controls, PWH and SOTRs had higher odds of HPV-related cancers compared with the unexposed group.
Meaning These findings suggest that immunosuppression elevates HPV-related cancer odds, highlighting the need for targeted vaccination, screening, and optimised clinical management in these populations.
Abstract
Importance
Human papillomavirus (HPV)–related cancers cause substantial morbidity and mortality. People with HIV (PWH) and solid organ transplant recipients (SOTRs) are at heightened risk due to impaired immune function, but direct comparisons of these groups within the same population are limited; understanding the relative risk and contributing factors is essential for targeted prevention and screening.
Objective
To compare the odds of HPV-related cancers in PWH and SOTRs with control participants and assess how clinical and sociodemographic factors modify these associations.
Design, Setting, and Participants
This nested case-control study used incidence density sampling within the Swedish population. Individuals born between 1940 and 2000 and who were a resident of Sweden from 1983 to 2024 were included. HPV-related cancer cases were matched 1:10 with controls based on sex, year of birth, and region of birth.
Exposure
HIV infection or history of organ transplant.
Main Outcome and Measures
The primary outcome was HPV-related cancers, identified via diagnostic codes from the Swedish Cancer Registry. Odds ratios (ORs) with 95% CIs of HPV-related cancers by immunosuppression were estimated using conditional logistic regression. In secondary analyses, comparisons were stratified by sex, age at cancer diagnosis, calendar period of diagnosis, HPV-related cancer site, region of birth, education, income, income type, and civil status.
Results
The study included 32 093 cases (21 206 female [65.5%]; 12 534 aged <50 years [39.4%]) and 320 930 matched control encounters (308 507 unique individuals; 201 667 female [65.4%]; 122 055 aged <50 years). Both PWH and SOTRs had elevated odds of HPV-related cancers compared with controls (PWH: adjusted OR [aOR], 4.50; 95% CI, 3.46-5.84; SOTRs: aOR, 2.23; 95% CI, 1.85-2.68). Among PWH, the highest site-specific odds were observed for anal (aOR, 58.79; 95% CI, 22.63-152.79) and penile (aOR, 8.05; 95% CI, 3.38-19.16) cancer. Among SOTRs, the highest odds were for vulvar (aOR, 7.07; 95% CI, 4.31-11.60) and penile (aOR, 6.01; 95% CI, 3.47-10.52) cancers, with variation by organ sites and time since transplant (>10 years posttransplant). In PWH, lower nadir (aOR 5.90; 95% CI, 4.04-8.61) and current (aOR, 8.62; 95% CI, 3.70-20.04) CD4 counts, shorter duration of viral suppression (aOR, 7.04; 95% CI, 4.40-11.27), and higher peak plasma HIV RNA levels (aOR, 5.66; 95% CI, 2.96-10.84) were associated with increased odds. In secondary analyses, sociodemographic factors such as lower income and nonmarried status were associated with elevated odds in both groups.
Conclusions and Relevance
In this case-control study of immunosuppressed populations, HPV-related cancer odds were increased among both PWH and SOTRs, with larger magnitudes of association observed in PWH; variation was observed by immune status, transplant characteristics, and sociodemographic factors. These findings highlight the need for enhanced prevention, including HPV vaccination, screening, and optimised immunosuppressive regimens.
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